Eating Disorders and Personality Problems (Element two)
For the patient suffering from each a character disorder and an consuming disorder BY FAR one of the most essential element in his mental abnormalcy is his eating disorders. He is usually right in emphasizing their significance to him more than the problems stemming from his character issues. They indicate the sturdy combined activity of an underlying sense of lack of private autonomy and an underlying sense of lack of self control. The patient feels inordinately, paralyzingly helpless and ineffective. His eating disorders are an work to exert and reassert mastery over his personal life. At this stage, he's unable to differentiate his personal feelings and requirements from these of other individuals. His cognitive and perceptual distortions (as an example, regarding his physique image) only improve his feeling of private ineffectiveness and his ought to physical exercise a lot more self handle (of his diet, the only issue left to him sice he belives that he lost handle more than every thing else in his life).
The patient doesn't trust himself AT ALL, not in the slightest. He's his worst enemy, a mortal enemy and he knows it. Consequently, any efforts to collaborate with HIM against his disorder - is going to be perceived by him as collaboration with his worst enemy against his only mode of controlling his life to some extent.
The patient views the world in terms of black and white, of absolutes. So, he can not let go even to an incredibly tiny degree. He (or she) is HORRIFIED - consistently - that even the slightest loosening of his rigid consuming regime will quickly deteriorate into a total loss of control more than his life. This is why he finds it impossible to form relationships: he mistrusts (himself and by extension other folks), he does not desire to turn out to be an adult, he will not appreciate sex or love (which both entail a modicum of a loss of manage). All these dysfunctions cause a chronic absence of self esteem. These sufferers appear to become actually attached only to their disorder. Their consuming disorder is their only successful feat in life. Otherwise they may be ashamed of themselves and disgusted by their shortcomings (expressed by means of shame and disgust directed at their bodies).
There's a possibility to remedy the patient of his eating problems (though the duality of eating disorder plus the existence of a character disorder is just not favourable prognosticator of recovery). This - and ONLY this - has to be accomplished in the 1st stage. The patient's family or closest ought to think about therapy And the patient's participation in assistance groups (the equivalent of Alcoholics Anonymous or perhaps a 12 step plan for consuming disorders). Recovery prognosis improves soon after 2 years of treatment and assistance. The household should be heavily involved inside the therapeutic process. Household dynamics usually contribute to the improvement of such problems.
Medication+ cognitive or behavioral therapy+psychodynamic therapy+family therapy ought to perform it.
The modify inside the patient In the event the remedy of his consuming issues is successful is extremely MARKED. His key depression disappears together with his sleeping issues. He becomes socially active once more and goes on together with the organization of living. His personality disorder might make it challenging for him - but, in isolation, with out the exacerbating circumstances of his other problems - he finds it much easier to cope with.
Sufferers with eating problems could be in mortal danger. Their behaviour is ruining their bodies relentlessly and inexorably. They may possibly try suicide. They may do drugs. It really is only a question of time. Our purpose is to get them time. The older they get, the more expertise they accumulate, the much more their physique chemistry modifications with age - as well as the greater their prognosis.
REFRRENCES:
(1) Assessment of General Psychiatry - 4th Edition - Prentice Hall International - 1995 - pp. 309-332 and 355-368
(2) Herzog DB et al. - The prevalence of character disorders in 210 women with consuming disorders - Journal of Clinical Psychiatry - 1992a;53:147
(three) Marcus MD et al. - Psychiatric issues among obese binge eaters - international Journal of Eating Problems - 1990;9:69
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